Implementing a care bundle approach reduces ventilator-associated pneumonia and delays ventilator-associated tracheobronchitis in children: differences according to endotracheal or tracheostomy devices.

OBJECTIVE: To reduce ventilator-associated infections (VARI) and improve outcomes for children. METHODS: This prospective interventional cohort study was conducted in a paediatric intensive care unit (PICU) over three periods: pre-intervention, early post-intervention, and late post-intervention. These children were on mechanical ventilation (MV) for ≥48h. RESULTS: Overall, 312 children (11.9% of whom underwent tracheostomy) and 6187 ventilator-days were assessed. There was a significant reduction in ventilator-associated pneumonia (VAP) among tracheostomized patients (8.16, 3.27, and 0.65 per 1000 tracheostomy ventilation-days before the intervention, after the general bundle implementation, and after the tracheostomy intervention, respectively). The median time from onset of MV to diagnosis of ventilator-associated tracheobronchitis (VAT) increased from 5.5 to 48 days in the late post-intervention period (p=0.004), and was associated with a significant increase in median 28-day ventilator-free days and PICU-free days. Tracheostomy (odds ratio 7.44) and prolonged MV (odds ratio 2.75) were independent variables significantly associated with VARI. A trend towards a reduction in PICU mortality was observed, from 28.4% to 16.6% (relative risk 0.58). CONCLUSIONS: The implementation of a care bundle to prevent VARI in children had a different impact on VAP and VAT, diminishing VAP rates and delaying VAT onset, resulting in reduced healthcare resource use. Tracheostomized children were at increased risk of VARI, but preventive measures had a greater impact on them.

Incidencia de hospitalizaciones por enfermedad neumocócica en niños con condiciones de riesgo en Cataluña (2005-2012) / Incidence of pneumococcal disease admissions in children with risk conditions in Catalonia (2005-2012)

INTRODUCCIÓN: Streptococcus pneumoniae es una causa importante de morbimortalidad. Los niños con ciertas patologías de base tienen más riesgo de presentar una enfermedad neumocócica, incluida la enfermedad neumocócica invasiva (ENI). El objetivo de este estudio es estimar las tasas de hospitalización por ENI en niños con condiciones de riesgo en Cataluña y describir sus características. MATERIAL Y MÉTODO: Estudio longitudinal retrospectivo de la incidencia de ingresos hospitalarios por ENI entre 2005 y 2012, en los niños menores de 16 años asignados a los centros de atención primaria del Institut Català de la Salut, con condiciones de riesgo para enfermedad neumocócica invasiva. La información se recogió a partir de la historia clínica electrónica de los equipos de atención primaria y del Conjunto Mínimo Básico de Datos de hospitalización de agudos. RESULTADOS: La tasa global de hospitalizaciones por ENI en niños con enfermedad de base fue de 43,1 casos por 100.000 personas-año (IC del 95%: 32,2-57,7). La tasa más alta se observó en los niños < 2 años (107,8 por 100.000 personas-año; IC del 95%: 69-168,3) y en aquellos con trastornos neuromusculares y/o fístula de líquido cefalorraquídeo (141,6 por 100.000 personas-año) y síndrome de Down (133,5 por 100.000 personas-año). CONCLUSIONES: La tasa de ingresos por ENI en población pediátrica con condiciones de riesgo en Cataluña es similar a la observada en otras series y superior a la descrita en población general. Es necesario implementar estrategias de vacunación dirigidas específicamente a estos grupos de alto riesgo

INTRODUCTION: Streptococcus pneumoniae is a significant cause of morbidity and mortality. Children with certain conditions are at risk of developing pneumococcal disease, including invasive pneumococcal disease (IPD). The aim of this study is to estimate admission rates for IPD in children with risk conditions in Catalonia, and to describe their characteristics. MATERIAL AND METHOD: Retrospective longitudinal study of admission rates due to IPD between 2005 and 2012 in children younger than 16 years referred by Primary Care Centres of the Catalan Institute of Health, with risk conditions for invasive pneumococcal disease. Information was obtained from electronic medical records in the Primary Care Centres and from the Minimum Basic Data Set (MBDS) of acute hospital admissions. RESULTS: The overall IPD hospital admission rate in children with underlying conditions was 43.1 cases per 100,000 persons-year (95% CI: 32.2-57.7). The rate was higher in children <2 years old (107.8 per 100,000 persons-year; 95% CI: 69-168.3), and in those with neuromuscular disease and/or cerebrospinal fluid leak (141.6 per 100,000 persons-year), and Down's syndrome (133.5 per 100,000 persons-year). CONCLUSIONS: The hospital admission rate due to IPD in children with risk conditions in Catalonia is similar to that observed in other series, and higher than that described in the general population. It is necessary to implement immunisation strategies aimed directly at these risk groups

[Incidence of pneumococcal disease admissions in children with risk conditions in Catalonia (2005-2012)]. / Incidencia de hospitalizaciones por enfermedad neumocócica en niños con condiciones de riesgo en Cataluña (2005-2012).

INTRODUCTION: Streptococcus pneumoniae is a significant cause of morbidity and mortality. Children with certain conditions are at risk of developing pneumococcal disease, including invasive pneumococcal disease (IPD). The aim of this study is to estimate admission rates for IPD in children with risk conditions in Catalonia, and to describe their characteristics. MATERIAL AND METHOD: Retrospective longitudinal study of admission rates due to IPD between 2005 and 2012 in children younger than 16 years referred by Primary Care Centres of the Catalan Institute of Health, with risk conditions for invasive pneumococcal disease. Information was obtained from electronic medical records in the Primary Care Centres and from the Minimum Basic Data Set (MBDS) of acute hospital admissions. RESULTS: The overall IPD hospital admission rate in children with underlying conditions was 43.1 cases per 100,000 persons-year (95% CI: 32.2-57.7). The rate was higher in children <2 years old (107.8 per 100,000 persons-year; 95% CI: 69-168.3), and in those with neuromuscular disease and/or cerebrospinal fluid leak (141.6 per 100,000 persons-year), and Down's syndrome (133.5 per 100,000 persons-year). CONCLUSIONS: The hospital admission rate due to IPD in children with risk conditions in Catalonia is similar to that observed in other series, and higher than that described in the general population. It is necessary to implement immunisation strategies aimed directly at these risk groups.

Cobertura de vacunación antigripal en niños con condiciones de riesgo en Cataluña / Influenza vaccination coverage in children with risk conditions in Catalonia

INTRODUCTION: Influenza vaccination is recommended in Catalonia in children older than 6 months with risk conditions for developing flu-related complications. The aim of this study is to determine influenza vaccine coverage in children with risk conditions and their association with socio-demographic factors and medical variables. MATERIAL AND METHOD: Descriptive cross-sectional study of children with risk conditions for developing influenza complications (aged between 6months and 15years old) assigned to Primary Health Care centers in Catalonia at the beginning of the 2011-2012 influenza vaccination campaign. The information on vaccination status and study variables were obtained from data registered on electronic health records by primary care teams. The relationship between influenza vaccination and demographic and medical variables was analyzed using bivariate analysis and a multiple logistic regression model. RESULTS:Influenza vaccination coverage was 23.9%. Variables associated with influenza vaccination were: age 2years or older (aOR: 1.6 [1.4-1.7] in children 3-5years old; 1.8 [1.7-2.0] in those 6-10 years, and 2.2 [2.0 -2.4] in children ≥11years]); male sex (aOR: 1.1 [1.0-1.1]); foreign nationality (aOR: 1.2 [1.2-1.3]); age-appropriate immunization according to the systematic immunization schedule (aOR: 3.3 [2.8-3.8]); more than one visit to the primary care physician (5 or more visits) (aOR: 4.1 [3.8-4.4]), and more than one risk condition (3 or more conditions) (aOR: 2.5 [1.6-3.9]). DISCUSSION: Compared to other countries, influenza vaccination coverage among children with risk conditions is low in our study. Strategies to improve coverage should be implemented

Introduction Influenza vaccination is recommended in Catalonia in children older than 6 months with risk conditions for developing flu-related complications. The aim of this study is to determine influenza vaccine coverage in children with risk conditions and their association with socio-demographic factors and medical variables. Material and method Descriptive cross-sectional study of children with risk conditions for developing influenza complications (aged between 6 months and 15 years old) assigned to Primary Health Care centers in Catalonia at the beginning of the 2011-2012 influenza vaccination campaign. The information on vaccination status and study variables were obtained from data registered on electronic health records by primary care teams. The relationship between influenza vaccination and demographic and medical variables was analyzed using bivariate analysis and a multiple logistic regression model. Results Influenza vaccination coverage was 23.9%. Variables associated with influenza vaccination were: age 2 years or older (aOR: 1.6 [1.4-1.7] in children 3-5 years old; 1.8 [1.7-2.0] in those 6-10 years, and 2.2 [2.0 -2.4] in children ≥ 11 years]); male sex (aOR: 1.1 [1.0-1.1]); foreign nationality (aOR: 1.2 [1.2-1.3]); age-appropriate immunization according to the systematic immunization schedule (aOR: 3.3 [2.8-3.8]); more than one visit to the primary care physician (5 or more visits) (aOR: 4.1 [3.8-4.4]), and more than one risk condition (3 or more conditions) (aOR: 2.5 [1.6-3.9]).DiscussionCompared to other countries, influenza vaccination coverage among children with risk conditions is low in our study. Strategies to improve coverage should be implemented (AU)

[Influenza vaccination coverage in children with risk conditions in Catalonia]. / Cobertura de vacunación antigripal en niños con condiciones de riesgo en Cataluña.

INTRODUCTION: Influenza vaccination is recommended in Catalonia in children older than 6 months with risk conditions for developing flu-related complications. The aim of this study is to determine influenza vaccine coverage in children with risk conditions and their association with socio-demographic factors and medical variables. MATERIAL AND METHOD: Descriptive cross-sectional study of children with risk conditions for developing influenza complications (aged between 6months and 15years old) assigned to Primary Health Care centers in Catalonia at the beginning of the 2011-2012 influenza vaccination campaign. The information on vaccination status and study variables were obtained from data registered on electronic health records by primary care teams. The relationship between influenza vaccination and demographic and medical variables was analyzed using bivariate analysis and a multiple logistic regression model. RESULTS: Influenza vaccination coverage was 23.9%. Variables associated with influenza vaccination were: age 2years or older (aOR: 1.6 [1.4-1.7] in children 3-5years old; 1.8 [1.7-2.0] in those 6-10 years, and 2.2 [2.0 -2.4] in children ≥11years]); male sex (aOR: 1.1 [1.0-1.1]); foreign nationality (aOR: 1.2 [1.2-1.3]); age-appropriate immunization according to the systematic immunization schedule (aOR: 3.3 [2.8-3.8]); more than one visit to the primary care physician (5 or more visits) (aOR: 4.1 [3.8-4.4]), and more than one risk condition (3 or more conditions) (aOR: 2.5 [1.6-3.9]). DISCUSSION: Compared to other countries, influenza vaccination coverage among children with risk conditions is low in our study. Strategies to improve coverage should be implemented.

Características de los pacientes y carga asistencial durante la pandemia de gripe A (H1N1) 2009 en el Hospital Universitario Vall d’Hebron de Barcelona / Patient characteristics and health care burden during the influenza A (H1N1) 2009 pandemic in the university Hospital Vall d’Hebron of Barcelona

La pandemia de gripe A (H1N1) 2009 repercutió inicialmente de forma leve en los hospitales de Cataluña, pero en el otoño se produjo una destacada onda pandémica. Se describen las principales características de los pacientes atendidos en el Hospital Universitaro Vall d’Hebron de Barcelona (HUVH) en el transcurso de la pandemia, la factores asociados a riesgo de hospitalización y la carga asistencial generada. Pacientes y métodos. Se incluyen todos los casos de gripe A (H1N1) 2009 con confirmación microbiológica, atendidos desde el 2 de julio de 2009 al 22 de enero de 2010. Se ha realizado un análisis descriptivo de los casos y un análisis multivariado para conocer las variables asociadas al riesgo de hospitalización. Resultados El diagnóstico se confirmó en 741 pacientes, de los que el 56,8% tenían menos de 16 años, mientras que los de 65 y más años representaron únicamente el 2,8%. Un 33% de los niños no presentaron ningún factor de riesgo de complicaciones, en cambio en los adultos fueron el 45%. Fueron hospitalizados 190 casos, de ellos 26 en UCI con 5 defunciones. La edad inferior a un año, la inmunodeficiencia y la patología neuromuscular fueron los factores asociados de forma significativa al riesgo de hospitalización en niños, y la patología crónica pulmonar en los adultos. El diagnóstico de neumonía en urgencias fue un factor determinante de hospitalización, tanto en niños como adultos. La máxima carga asistencial se registró el 19 de noviembre con 43 pacientes hospitalizados, 6 de ellos en UCI.(..) (AU)

Background and objective: The influenza A(H1N1) 2009 pandemic initially had a mild impact in Catalonian hospitals, but in the autumn there was an important pandemic wave. We describe the main characteristics of patients seen in the Vall d’Hebron University Hospital in Barcelona (HUVH) during this pandemic, the risk factors associated with hospitalization and the health-care burden generated. Material and method: We included all cases of influenza A (H1N1) 2009 with laboratory confirmation seen in the HUVH from July 2, 2009 to January 22, 2010. We performed a descriptive analysis of the cases and a multivariate analysis to identify variables associated with the risk of hospitalization. Results: The diagnosis was confirmed in 741 patients; 56.8% were under 16 years, while only 2.8% were 65and over. Thirty three per cent of children had no risk factor for complications, whereas in adults itwas45%.One hundred and ninety cases were hospitalized, 26 of them in the intensive care unit (ICU) with 5 deaths. The factors associated with risk of hospitalization were, age less than one year, immunodeficiency, and neuromuscular disease in children; and chronic lung disease in adults. The diagnosis of pneumonia in the emergency department was an important predictor of hospitalization in both children and adults. The maximum caseload was recorded on November 19, with 43 hospital admissions, 6 of them in the ICU. Conclusions: Between July and September 2009 the pandemic had a low impact on hospital resources, but in autumn there was a marked increase in emergency department visits and hospitalizations. Children had higher rates of confirmed cases, while adults had higher rates of hospitalizations. The risk of hospitalization was higher in patients with certain conditions especially in those with pneumonia. The pandemic wave was a moderate work load for HUVH, since it did not involve any modification of the usual healthcare programs (AU)

[Patient characteristics and health care burden during the influenza A (H1N1) 2009 pandemic in the university Hospital Vall d'Hebron of Barcelona]. / Características de los pacientes y carga asistencial durante la pandemia de gripe A (H1N1) 2009 en el Hospital Universitario Vall d'Hebron de Barcelona.

BACKGROUND AND OBJECTIVE: The influenza A (H1N1) 2009 pandemic initially had a mild impact in Catalonian hospitals, but in the autumn there was an important pandemic wave. We describe the main characteristics of patients seen in the Vall d'Hebron University Hospital in Barcelona (HUVH) during this pandemic, the risk factors associated with hospitalization and the health-care burden generated. MATERIAL AND METHOD: We included all cases of influenza A (H1N1) 2009 with laboratory confirmation seen in the HUVH from July 2, 2009 to January 22, 2010. We performed a descriptive analysis of the cases and a multivariate analysis to identify variables associated with the risk of hospitalization. RESULTS: The diagnosis was confirmed in 741 patients; 56.8% were under 16 years, while only 2.8% were 65 and over. Thirty three per cent of children had no risk factor for complications, whereas in adults it was 45%. One hundred and ninety cases were hospitalized, 26 of them in the intensive care unit (ICU) with 5 deaths. The factors associated with risk of hospitalization were, age less than one year, immunodeficiency, and neuromuscular disease in children; and chronic lung disease in adults. The diagnosis of pneumonia in the emergency department was an important predictor of hospitalization in both children and adults. The maximum caseload was recorded on November 19, with 43 hospital admissions, 6 of them in the ICU. CONCLUSIONS: Between July and September 2009 the pandemic had a low impact on hospital resources, but in autumn there was a marked increase in emergency department visits and hospitalizations. Children had higher rates of confirmed cases, while adults had higher rates of hospitalizations. The risk of hospitalization was higher in patients with certain conditions especially in those with pneumonia. The pandemic wave was a moderate work load for HUVH, since it did not involve any modification of the usual health care programs.

Effectiveness of varicella vaccines as postexposure prophylaxis.

BACKGROUND: Although chickenpox is usually a mild disease, it is not always free of complications, especially in adolescents and adults. Previous studies of postexposure prophylaxis conducted with experimental vaccines showed the vaccine to be highly effective if administered in the first 3 to 5 days after exposure. However, studies carried out with commercialized vaccines yielded discordant results. The aim of the present study was to assess the effectiveness of currently available varicella vaccines as postexposure prophylaxis. METHODS: We conducted a prospective cohort study. Patients susceptible to chickenpox consulting at the Preventive Medicine Department of the Vall d'Hebron Hospital after household exposure to a case of chickenpox were included. Postexposure prophylaxis with varicella vaccine was administered within the first 5 days after contact. Subjects were interviewed by telephone between 4 and 8 weeks after vaccination to ascertain whether chickenpox had appeared and, if so, its severity. The effectiveness of the vaccine in preventing and attenuating the disease was calculated with a confidence interval of 95%. RESULTS: Sixty-seven subjects were included in the study. Effectiveness of the varicella vaccine in preventing any type of disease was 62.3% (CI 95%: 47.8-74.9) and 79.4% (CI 95%: 66.4-88.9) in preventing moderate and severe disease. No statistically significant differences were found when effectiveness was compared according to sex, age, or days elapsed since exposure. CONCLUSIONS: Administration of varicella vaccines within the first 5 days postexposure is effective in preventing chickenpox and in attenuating the illness.

Prevalencia de las infecciones en los hospitales españoles. Estudio EPINE. Resultados de los estudios de 2004, 2005, 2006 y 2007, y evolución 1990-2007: 18 años. Resultados Generales / No disponible

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